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Hepatic Lobectomy for Non-Cirrhotic HCC: Feasibility and Outcome in A Low-Resource Environment

Itekena Eugene Wakama, Michael Ekemena Ogba, Se-erena Seleye-Fubara

Abstract

Hepatocellular carcinoma is the most common primary malignancy of the liver, typically arising in the setting of chronic liver disease and cirrhosis. However, a minority of cases occur in non-cirrhotic livers, often presenting diagnostic challenges. We report a case of a 42-year-old male who presented with a 7-month history of progressive abdominal swelling, mild pain, anorexia, and weight loss. He had been treated empirically for presumed peptic ulcer disease without relief before the discovery of an abdominal mass. Clinical and radiological evaluation revealed a large left hepatic lobe mass measuring approximately 13.2 × 10.9 cm involving segments II and III. Serum alpha-fetoprotein was normal. The patient underwent successful left hepatic lobectomy (segments II and III) with a total operative time of 83 minutes and estimated blood loss of 200 mL. Histopathological analysis confirmed a poorly differentiated hepatocellular carcinoma measuring 18.0 cm in greatest dimension with visceral peritoneal perforation (pT3, Nx, Mx). The postoperative course was uneventful, and the patient was commenced on adjuvant sorafenib therapy. Notably, this case represents one of the earliest documented instances of a successful liver resection for HCC performed in the South-South region of Nigeria, a low- and middle-income country setting. This report highlights the occurrence of aggressive HCC in the absence of underlying liver disease or elevated tumour markers and underscores the feasibility of surgical resection in achieving favourable outcomes even within resource- constrained healthcare infrastructures.

References

Konyn P, Ahmed A, Kim D. The current trends in the health burden of primary liver cancer across the globe. Clin Mol Hepatol. 2023;29(2):358. Konyn P, Ahmed A, Kim D. Current epidemiology in hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol. 2021;15(11):1295–307. Desai A, Sandhu S, Lai JP, Sandhu DS. Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review. World J Hepatol. 2019;11(1):1. Suputra I, Saputra IWE. Non-cirrhotic hepatocellular carcinoma with duodenal metastasis in chronic hepatitis B: Case report. Int J Scient Adv. 2022;3(5):758–61. Gawrieh S, Dakhoul L, Miller E, Scanga A, DeLemos A, Kettler C, et al. Characteristics, aetiologies and trends of hepatocellular carcinoma in patients without cirrhosis: a United States multicentre study. Aliment Pharmacol Ther. 2019;50(7):809–21. Castán A, Navarro Y, Sarría L, Larrosa R, Serradilla M, Serrablo A. Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients. Hepatoma Res. 2017;3:1–17. Alkofer B, Lepennec V, Chiche L. Hepatocellular cancer in the non-cirrhotic liver. J Visc Surg. 2011;148(1):3–11. Jesuyajolu DA, Okeke C, Obi C, Nicholas A. Access to quality surgical care in Nigeria: a narrative review of the challenges, and the way forward. Surgery in Practice and Science. 2022;9:100070. Grimes CE, Bowman KG, Dodgion CM, Lavy CBD. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35(5):941–50. Ekpe EE, Peter AI. Surgical patient’s satisfaction with services at a tertiary hospital in south-south state of Nigeria. J Med Res. 2016;2(5):157–62. Bihain C, Delwaide J, Meunier P, Gerard L, Jadoul A, Detry O. Successful multimodal management of a large hepatocellular carcinoma in a non-cirrhotic liver: a case report. Acta Chir Belg. 2024;124(3):229–33. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, S taging, and M anagement of H epatocellular C arcinoma: 2018 P ractice G uidance by the A merican A ssociation for the S tudy of L iver D iseases. Hepatology. 2018;68(2):723–50. Young AL, Adair R, Prasad KR, Toogood GJ, Lodge JPA. Hepatocellular carcinoma within a noncirrhotic, nonfibrotic, seronegative liver: surgical approaches and outcomes. J Am Coll Surg. 2012;214(2):174–83. Mownah OA, Aroori S. The Pringle maneuver in the modern era: A review of techniques for hepatic inflow occlusion in minimally invasive liver resection. Ann Hepatobiliary Pancreat Surg. 2023;27(2):131–40. Hester CA, El Mokdad A, Mansour JC, Porembka MR, Yopp AC, Zeh III HJ, et al. Current pattern of use and impact of Pringle maneuver in liver resections in the United States. Journal of Surgical Research. 2019;239:253–60. Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg. 1998;187(6):620–5. Krige A, Kelliher LJS. Anaesthesia for hepatic resection surgery. Anesthesiol Clin. 2022;40(1):91–105. Wu G, Chen T, Chen Z. Effect of controlled low central venous pressure technique on postoperative hepatic insufficiency in patients undergoing a major hepatic resection. Am J Transl Res. 2021;13(7):8286. Mangla V, Lalwani S, Mehrotra S, Mehta N, Nundy S. Liver parenchymal transection techniques. Bhutan Health Journal. 2016;2(1):23–7. Lesurtel M, Selzner M, Petrowsky H, McCormack L, Clavien PA. How should transection of the liver be performed?: a prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg. 2005;242(6):814–23. Richter S, Kollmar O, Schuld J, Moussavian MR, Igna D, Schilling MK. Randomized clinical trial of efficacy and costs of three dissection devices in liver resection. Journal of British Surgery. 2009;96(6):593–601. Scatton O, Brustia R, Belli G, Pekolj J, Wakabayashi G, Gayet B. What kind of energy devices should be used for laparoscopic liver resection? Recommendations from a systematic review. J Hepatobiliary Pancreat Sci. 2015;22(5):327–34. Rau HG, Schardey HM, Buttler E, Reuter C, Cohnert TU, Schildberg FW. A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter. European Journal of Surgical Oncology . 1995;21(2):183–7. Meara JG, Greenberg SLM. The Lancet Commission on Global Surgery Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery. 2015;157(5):834–5. Lin TY. A simplified technique for hepatic resection: the crush method. Ann Surg. 1974;180(3):285–90. Takayama T, Makuuchi M, Kubota K, Harihara Y, Hui AM, Sano K, et al. Randomized comparison of ultrasonic vs clamp transection of the liver. Archives of surgery. 2001;136(8):922–8. Jonas E, Bernon M, Robertson B, Kassianides C, Keli E, Asare KO, et al. Treatment of hepatocellular carcinoma in sub-Saharan Africa: challenges and solutions. Lancet Gastroenterol Hepatol. 2022;7(11):1049–60. Khan AH, Mahmud O, Fatimi AS, Ahmed S, Wiener AA, Nishtala M V, et al. A Systematic Review and Meta‐Analysis of Oncologic Liver Resections in Low‐and Middle‐Income Countries: Opportunities to Improve Evidence and Outcomes. J Surg Oncol. 2025;131(5):865–78.